Avoid diabetes complications

Diabetes the unfinished story

1. Keep blood sugar levels as close to normal as safely possible.

High blood sugar levels harm health in many ways — and the higher the blood glucose levels over time, the greater the risk of developing complications. Long-term complications from diabetes fall into three categories:

The microvascular disease

 affects the small blood vessels of the body (such as those in the eyes and kidneys).

Nerve damage (neuropathy)

 often affects the feet. It may also impair the automatic function of various organ systems, including the intestines, bladder, and heart, resulting in altered digestion, incontinence, arrhythmias, and sexual dysfunction.

The macrovascular disease 

affects the body’s larger blood vessels, leading to heart disease, stroke, and blockages in leg arteries.

Keeping your blood glucose levels as close to normal as possible helps prevent microvascular disease and nerve damage. If your HbA1c level is 7% or higher, your therapy should be adjusted.

2. Keep blood pressure under a maximum of 140/90 mm Hg.

Ideally, blood pressure should be under 130/80. Keeping blood pressure tightly controlled can reduce the rate of progression of kidney damage. Losing weight and reducing salt intake can help keep blood pressure at healthy levels. If medications are needed, most doctors prescribe ACE inhibitors or angiotensin-receptor blockers to control high blood pressure in people with diabetes. These drugs retard the progression of kidney disease and may be used to treat microalbuminuria even when blood pressure is normal. Two or more types of blood pressure medications are often required to keep blood pressure within an acceptable range.

3. Aim to keep your cholesterol at healthy levels.

LDL (unhealthy) cholesterol levels should be under 100 mg/dL. HDL (healthy) cholesterol should be over 40 mg/dL if you are a man or over 50 mg/dL if you are a woman. Triglyceride levels should be below 150 mg/dL. 

Heart disease can be prevented and treated. That’s why early detection of high cholesterol, high triglycerides, and hypertension is so vital. A fasting blood test can measure levels of LDL, HDL, and total cholesterol, as well as triglyceride levels. Because hypertension usually has no symptoms, it’s important to have your blood pressure checked regularly.

If you have any chest pain or pressure, trouble breathing, or lightheadedness, you should be examined for heart disease. Don’t delay seeking treatment. Because nerve damage can blunt or change the usual symptoms of angina, people with diabetes must also watch for jaw or arm discomfort during or after physical activity, dizziness, or shortness of breath after minimal exercise.

4. Practice good foot care.

Peripheral and autonomic neuropathy are common diabetes complications. Diminished blood flow from the blockage of the arteries feeding the foot can impair pain sensation and impede the body’s infection fighters. People with these conditions must carefully check their feet and toes every day for a possible injury. Here are some basic steps to help take care of your feet:

• Know your feet. Take a good look every day to see if you’ve cut or bruised your feet without realizing it. Pay attention to any growths or discoloration. If your foot swells or changes in color, for example, it could be a sign of a fractured bone or poor circulation.
• Practice good foot hygiene. Wash your feet every day. Dry them thoroughly, especially between the toes. Moisturize any dry skin (but not between your toes), or dust with foot powder to keep your feet dry. Cut the nails straight across to avoid ingrown toenails, which can lead to infection. However, be careful when wielding the scissors: if you’ve lost sensation in your feet, or if your nails have hardened, consider having your nails trimmed professionally.
• Protect your feet. Wear shoes with ample cushioning and socks that protect against friction. Make sure your shoes fit by having your foot measured every time you buy a new pair. Avoid high heels or shoes with pointy toes. If you must wear such shoes for dressy occasions, try to limit the amount of time they are on your feet.
• Lose weight if you’re overweight. Every extra pound increases the pressure on your feet.
• Exercise regularly. Exercise, such as walking, improves circulation.
• Don’t smoke and drink in moderation. Smoking impairs circulation. Avoid excessive consumption of alcohol, which can impair nerves already at risk because of diabetes. Government health agencies and the American Medical Association define moderate drinking as no more than two standard drinks per day for men under age 65 and one drink per day for women. (A drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor.)
• Learn when to seek help. If you have diabetes, you’re also more prone to complications. If you develop any of the foot problems, it’s vital that you see a doctor. Don’t try to treat yourself at home.
• Apply for Medicare-funded shoes. Medicare covers the cost of therapeutic shoes and inserts for people with diabetes, in an effort to reduce foot and leg amputations. Medicare covers 80% of the approved cost for durable equipment (which can include shoes as well as insulin pumps and other therapeutic devices), after you have met the annual deductible.

5. Schedule regular visits with your doctor to assess your overall health.

Your regular medical visits should consist of checking for the presence of any diabetes complications as well as ways to reduce your risk of complications. According to the National Institute of Diabetes and Digestive and Kidney Diseases, you should see your health care team at least twice a year to find and treat and problems early. Here are some important appointments you should make:

• Primary care/endocrinologist — every 3 to 6 months for an exam that should include checking your blood pressure, weight, and feet
• Dentist — every 6 months or more frequently, if necessary
• Optometrist/Ophthalmologist — dilated eye exam annually or bi-annually if the exam shows no problems developing
• Podiatrist — annually for a comprehensive exam that includes checking for calluses, infections, sores, and loss of feeling

Also remember to have your A1C tested at least twice a year, get a urine and blood test to check for kidney problems, and get a flu shot as well as pneumonia shot.

The lower a food’s glycemic index, the slower and lower blood sugar rises after eating that food. A glycemic index of 55 or below is considered low; 70 or above is considered high. In general, the more cooked or processed a food is, the higher its GI, and the more fiber or fat in a food, the lower the GI.

The glycemic index tells just part of the story because it indicates only how fast a particular carbohydrate-rich food raises blood sugar. What it doesn’t tell you is how high your blood sugar could go when you actually eat the food, which is partly determined by how much carbohydrate is in a serving of a particular food. To understand a food’s complete effect on blood sugar, you need to know both how quickly it makes glucose enter the bloodstream and how much glucose it can deliver.

Understanding glycemic load

A separate measure called the glycemic load gives a more accurate picture of a food’s real-life impact on blood sugar. The glycemic load is determined by multiplying the grams of carbohydrate in a serving by the glycemic index and dividing by 100. A glycemic load of 10 or below is considered low; 20 or above is considered high. Watermelon, for example, has a high glycemic index (80). But a serving of watermelon has so little carbohydrate (6 grams) that its glycemic load is only 5.

Some nutrition experts believe that people with diabetes should pay attention to the glycemic index and glycemic load to avoid sudden spikes in blood sugar. A review by the Cochrane Collaboration (an international group of health authorities who evaluate evidence from randomized clinical trials) found that people who followed a low-GI diet lowered their HbA1c levels by 0.5 percentage point — and they were also less likely to experience hypoglycemia. To put that effect into perspective, the FDA considers a drop in HbA1c of as little as 0.4 of a percentage point to be meaningful when assessing drugs to treat diabetes.

The American Diabetes Association acknowledges the value of the glycemic index and glycemic load, saying that “substituting low-glycemic-load foods for higher-glycemic-load foods may modestly improve” blood sugar control. But it also says that the total amount of carbohydrate in a food, rather than the food’s glycemic index or load, is a stronger predictor of what will happen to blood sugar. Some dietitians feel that focusing on the glycemic index and glycemic load adds an unneeded layer of complexity to choosing what to eat. The bottom line? Following the principles of low-glycemic-index eating is likely to be beneficial, as it essentially encourages a high-fiber diet that is moderate in carbohydrates, but reaching and staying at a healthy weight is more important for your blood sugar and your overall health.

4 principles of low-glycemic eating

• Eat non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts.
• Eat grains in the least-processed state possible: “unbroken” grains such as whole barley, millet, wheat berries, brown rice, and whole-kernel bread; or traditionally processed grains such as stone-ground whole-grain bread, steel-cut oats, and natural granola or muesli breakfast cereal.
• Cut back or cut out white potatoes and refined grain products such as white bread, bagels, pastries, and regular pasta.
• Let concentrated sweets — including high-calorie foods with a low glycemic index, such as ice cream — be an occasional treat instead of a staple. Don’t drink more than one-half cup of fruit juice a day. Completely eliminate sugar-sweetened drinks.